[Nfbmt] Call For Action

[Travis S. Moses]

Greetings Members,

We had a full meeting on Saturday in passing an at-large chapter
constitution.  But we didn't get to talk about the status of the Medicaid
issue proposed by the Department of Public Health and Human Services to pay
for O & M for blind kids in K through 12.


There is a proposed rule.  There was a public hearing in Helena today,
though none of us were able to attend for various reasons.  However, the
comment period is still open until May 23. That gives us a week to act.

We need to act  because those that support using Medicaid for K-12 O & M are
putting the word out to ask for support.  We need to ensure that the voices
of those that oppose medicalizing blindness and blindness-related services
are heard.

Here is the proposed Medicaid rule:

NEW RULE I  EARLY AND PERIODIC SCREENING, DIAGNOSTIC AND TREATMENT SERVICES
(EPSDT), ORIENTATION AND MOBILITY SPECIALIST SERVICES (1)  Orientation and
Mobility Specialist Services are those services provided by an individual
with:

(a)  a certification from the Academy for Certification of Vision
Rehabilitation and Education Professionals (ACVREP); or

(b)  a National Orientation and Mobility Certification (NOMC) offered by the
National Blindness Professional Certification Board (NBPCB) to Medicaid
clients
with a diagnosis of a visual impairment.

(2)  Orientation and Mobility Specialist Services are medically necessary
services provided to Medicaid clients whose health conditions cause them to
need
vision-assisted services. 

AUTH:  53-2-201, 53-6-101, 53-6-113, MCA

What to do - 

We need to say that we oppose this rule.  Start by saying that you are blind
and a member of the NFB of Montana.  Then cover the following:

1.	Blindness is not a health condition, and should not be musicalized
2.	O & M services are already required educational services and as such
are funded, Frank Podobnik of OPI has indicated that to be the case. 
3.	We are concerned that this rule will cause costs to go up and will
make O & M services less accessible to all Montana children, rather than
more accessible.

"Nothing about us without us" is the motto of many disability rights
activists, and it applies here.

*****

Send comments to:


7.  Concerned persons may submit their data, views, or arguments either
orally or in writing at the hearing.  Written data, views, or arguments may
also
be submitted to: Kenneth Mordan, Department of Public Health and Human
Services, Office of Legal Affairs, P.O. Box 4210, Helena, Montana,
59604-4210; fax
(406) 444-9744; or e-mail 
dphhslegal at mt.gov,
and must be received no later than 5:00 p.m., May 23, 2013. 


Prior to leaving in April, Dan Burke submitted the following on behalf of
the NFB of Montana.  But we need to have more comments.
***

This is obviously the core of the new rule and related changes, and of
course the core of our disagreement, though there are other points as
well.  Blindness and low vision (visual impairment) may be associated
with health conditions that require or may benefit from medical
intervention I(diabetes, glaucoma, cataracts, etc.), but blindness and
visual impairment themselves are not health conditions as such, and
those services which are necessary are educational services, not
medical services.  This applies to Orientation and Mobility
instruction, and absolutely critical service to the development of a
successful, self-determining independent adult, as are services such
as Braille and the use of other alternative techniques and strategies
for learning, working and day-to-day activities.  It is decidedly
developmental, but no more medical for a blind child than for any
child to learn to read or do fractions.  It is the very custodialism
of this thinking that is so objectionable to us in the National
Federation of the Blind, revealing as it does such disabling attitudes
of the education system and society in general toward blind and
visually impaired students and ultimately blind adults.

Having said that, I will focus on the language of (2) of the new rule.

*  replace "health conditions" with blindness or visual impairment.
You can check with Frank Podobnik or Steve Gettel about this, but I
believe that is the language required for the IEP, and it seems to me
it should be parallel here
* What is "vision assisted services?"  My guess is it is not a term
defined in law or regs for education or Medicaid, but I may be wrong.
In any case the term is so inoffensive as to be  of no use. In fact, O
& M is not a "vision assisted service," but one of the alternative
strategies of blindness and visual impairment.  It is much like the
practice of referring to teachers of the blind as "vision teachers,"
when vision is the thing least involved in a blind child's learning.
The term does betray, however, the prejudice that blind people are
broken sighted people. It has no place in our state government or
rules.  And again, it makes sense to keep the language parallel with
the IEP.

Here are my suggested revisions:

(2)     Orientation and Mobility services are educationally necessary
services provided to Medicaid clients whose blindness or visual
impairments cause them to need services in alternative techniques of
blindness and visual impairment.

Duane, I very much appreciate your openness and forthrightness in
sharing the process under way and the draft of the rule.  That is
top-notch public service in the best tradition of Montana government
and our state Constitution.  At the same time, the process at hand and
the language and the attitudes underlying them are absolutely
abhorrent to me.  Good intentions are no guarantee of good works, and
misguided compassion too often is as deleterious as the old radical
saw--  "the booted heel on the throat of the oppressed."  This is
especially true when there is at best scant evidence that blind and
visually impaired children in Montana will benefit from this rule
change.

Further, this entire discussion was initiated without any kind of
consensus in the "blindness community," though you may have been led
to believe otherwise.  It breaks down almost on the lines of
professionals versus the NFB, with only a few informed exceptions.
Thus, it is not a good foundation for public policy.

This has taken me all morning to write and I have been compelled to
revise regularly and delete often as I danced none too steadily along
the line between reasoned argument and rant.  Our passion - my passion
- about this stems from our view that blind kids are our spiritual
children and we are bound to do our best to do right by them, just as
I know that you feel the same in your role.  But this rule is
custodial and does harm.  We will of course submit our arguments in
opposition to it

Thanks again. Very respectfully,
Dan

***

... Our opponents have history and outmoded concepts on their side. We
have democracy and the future on ours. For the sake of those who are
now blind and those who hereafter will be blind-and for the sake of
society at large-we cannot fail.

***

In the Sixteenth Century, John Bradford made a famous remark which has
ever since been held up to us as a model of Christian humility and
correct charity and which you saw reflected in the agency quotations I
presented. Seeing a beggar in his rags creeping along a wall through a
flash of lightning in a stormy night Bradford said: "But for the Grace
of God, there go I." Compassion was shown; pity was shown; charity was
shown; humility was shown; there was even an acknowledgement that the
relative positions of the two could and might have been switched. Yet
despite the compassion, despite the pity, despite the charity, despite
the humility, how insufferably arrogant! There was still an
unbridgeable gulf between Bradford and the beggar. They were not one
but two. Whatever might have been, Bradford thought himself Bradford
and the beggar a beggar-one high, the other low; one wise, the other
misguided; one strong, the other weak; one virtuous, the other
depraved.

We do not and cannot take the Bradford approach. It is not just that
beggary is the badge of our past and is still all too often the
present symbol of social attitudes towards us; although that is at
least part of it. But in the broader sense, we are that beggar and he
is each of us. We are made in the same image and out of the same
ingredients. We have the same weaknesses and strengths, the same
feelings, emotions, and drives; and we are the product of the same
social, economic, and other environmental forces. How much more
consonant with the facts of individual and social life, how much more
a part of a true humanity, to say instead: "There, within the Grace of
God, do go I."

-- Jacobus TenBroek, 1956
https://nfb.org/Images/nfb/Publications/convent/tb1956.htm


Travis S. Moses, President
National Federation of the Blind of Montana
chiefblindtech at gmail.com 
Phone: 406-369-5605
www.nfbmt.org